Trusting Relationships and Information Lead to Vaccination Success

Letoia Clark (right) answers a patient's questions at KC Care Health Center in Kansas City, Missouri.

Letoia Clark, PharmD, administered vaccines at one of Kansas City’s first mass vaccination events at Arrowhead Stadium in Kansas City, Missouri. She saw many people cry tears of joy that day, but one person in particular stood out.

The 40-something woman told Clark that she was a florist and that over the last year, her business had been one funeral after another—a reflection of the death toll of COVID-19. “She felt that getting the vaccine was something she could do for all the customers whose stories she’d heard that year, the people who’d had to bury their spouses, their parents, or their siblings.”

A study of the root causes of vaccine hesitancy

At KC Care, a federally qualified health center in Kansas City, Missouri, where Clark is a resident, most patients were equally eager to get their vaccine. But Clark knew that not everyone was going to accept the vaccine right away. So, she launched a study to help clinic staff head vaccine hesitancy off at the pass.

“I wanted to find out the reasons patients in a federally qualified health center might be reluctant or refuse to get the COVID-19 vaccine,” she said. That way clinicians could be prepared for some of the concerns they might hear during encounters with patients.

Clark’s survey found three common concerns among this patient population. Some patients worried about immediate and possible long-term adverse effects of the vaccine. Others didn’t understand how the vaccine worked. Some worried about how new the vaccine was.

“People weren’t confident about getting the vaccine because, to them, it just kind of came out of nowhere,” Clark explained. The survey also found that white patients were most likely to get vaccinated, Black patients were least likely, and Hispanic patients fell somewhere in the middle.

Diversity in clinical trials

Clark and her colleagues heard around the clinic that some Black patients felt they had been underrepresented in clinical trials of the vaccine. Clark said she feels it’s important to stress to patients who voice this concern that this may happen in clinical trials not because investigators skip over Black people but because they may be less likely to volunteer.

KC Care also serves a large population of patients living with HIV. Clark and other clinicians found about a 50/50 split among them in their willingness to get the vaccine. For some, their potentially weakened immune system was all the more reason to roll up their sleeve and get the vaccine. For others, it was a reason to avoid it.

Armed with this information, clinic staff set out to lower the barriers to vaccination as much as possible.

“Once the vaccine was available, and we knew we were getting it, a team was built specifically to handle and manage vaccine distribution and organization,” Clark said.

Lowering barriers to vaccination

For starters, they kept the scheduling procedure simple. Rather than navigate an online booking system, eligible patients simply needed to send an e-mail stating their interest in getting the vaccine, and a clinic staff member called them back with an appointment.

When patients voiced concerns about the vaccine, Clark said, clinicians listened and shared the facts.

In response to concerns about adverse effects, Clark and her colleagues cited data about the effects and pointed out that they were shortlived and similar to those of the flu vaccine. “It’s just our body’s natural response to something being injected into it and trying to build an immune response to it.”

As for patients who have HIV, clinicians explained that they were eligible for the vaccine regardless of their viral load and that it would protect people with a potentially weakened immune system—not hurt them.

“We stick with information that CDC, WHO, and the vaccine manufacturers provide, and we consistently educate our patients with the most accurate and up-to-date information we have.”

Trusting relationships make a difference

Ultimately, the overwhelming majority of patients at KC Care have accepted the COVID-19 vaccine. Clark credits the trusting relationships clinicians cultivate with their patients. And she offers advice for other clinicians who want to foster this type of trust with patients: Listen to their “why.”

“It’s important to pinpoint the reason for the reluctance or refusal to vaccinate in the first place,” Clark said. “It’s not enough to ask a patient if they want a COVID-19 vaccine, and if they say no, to move on. Ask why. Once you’re able to identify that concern, you can acknowledge it and offer education, support, and the most accurate research and data so the patient can make the most informed decision.”